MEDICARE: MIGUELA TALAVERA GUTIERREZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101026126	VA

General Provider Information

NPI Number	:	1518944636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUELA TALAVERA GUTIERREZ MD

Provider Business Mailing Address
First Line	:	509 THOMAS BRANSBY
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-8244
Country	:	US
Telephone Number	:	757-314-7682
Fax Number	:	757-314-7511

Provider Business Practice Location Address
First Line	:	MCDONALD ARMY COMMUNITY HOSPITAL
Second Line	:	BLDG 576
City	:	FT EUSTIS
State	:	VA
Zip	:	23604
Country	:	US
Telephone Number	:	575-314-7682
Fax Number	:	757-314-7511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	07/08/2007

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